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Nursing Management of Eating Disorders

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  1. Nursing Management of Eating Disorders NUR 265 Pat Mitchell, RN, MS

  2. Eating Disorders • Anorexia nervosa • Bulimia nervosa • Eating disorder not otherwise specified (NOS) • Binge eating disorder

  3. Eating Disorders: Theories Separate syndromes based on a cluster of symptoms • Neurobiological • Altered neurotransmitters • Neuroendocrine • Abnormalities noted • Causal relationship possible • May be result of starvation or abnormal eating behavior

  4. Eating Disorders: TheoriesContinued • Psychological models • Core psychopathology • Feelings of • Low self esteem • Self-doubts about personal worth • Feelings produce harsh self-judgment focused on weight

  5. Eating Disorders: TheoriesContinued • Sociocultural models • Incidence of eating disorders increases in societies in which women have a choice in social roles • Genetic models • Strong genetic link for eating disorders

  6. Eating Disorder Cycle

  7. Signs and Symptoms and Clinical Presentations of Anorexia and Bulimia • Anorexia nervosa (Table 17-1) • Bulimia nervosa (Table 17-1)

  8. Anorexia Nervosa Physical Symptoms • Weight loss 15% below ideal • Amenorrhea • Bradycardia, subnormal T • Cachexia, sunken eyes, dry skin • Lanugo on face • Constipation • Cold sensitivity

  9. Anorexia Nervosa Behavioral Symptoms • Self-starvation • Compulsive behaviors regarding food • May use laxatives or diuretics, excessive exercise, vomiting • Wearing baggy clothes

  10. Anorexia Nervosa Psychologic Symptoms • Denial of seriousness of low weight • Body image disturbance • Irrational fear of weight gain • Constant striving for perfect body • Self-concept unduly influenced by shape and weight • Preoccupation with food, cooking • Delayed psychosexual development • Little interest in sex, relationships

  11. Bulimia Nervosa Physical Symptoms • Electrolyte imbalances • Hypokalemia • Alkalosis • Dehydration • Idiopathic edema Cardiovascular • Hypotension • Dysrhythmias • Cardiomyopathy

  12. Bulimia Nervosa Physical Symptoms, cont’d. Endocrine • Hypoglycemia • Menstrual dysfunction Gastrointestinal • Constipation, diarrhea • Gastroparesis • Esophageal reflux • Esophagitis • Esophageal tears

  13. Bulimia Nervosa Physical Symptoms, cont’d. Dental • Enamel erosion Parotid Gland Enlargement

  14. Bulimia Nervosa Behavioral Symptoms • Recurrent episode of binge eating • Purging behavior to compensate • Self-induced vomiting, use of laxatives, diuretics, enemas, fasting, excessive exercise

  15. Bulimia Nervosa Psychologic Symptoms • Body image disturbance • Persistent over concern with weight, shape, proportions • Mood swings, irritability • Self-concept unduly influenced by weight

  16. Medical Complications of Anorexia and Bulimia Nervosa • Medical complications are listed in Box 17-1

  17. Therapeutic Relationship: Building Trust and Having Empathy • Client with anorexia nervosa • Perfectionism • Obsessive thoughts and actions relating to food • Need to control

  18. Anorexia Nervosa: Nursing Process • Assessment • Nursing diagnosis • Outcome criteria • Short-term • Long-term • Planning • Refeeding syndrome

  19. Anorexia Nervosa: Intervention • Acute phase/basic level intervention • Milieu therapy • Precise meal times and menus • Observation during and after meals • Regularly scheduled weighing • Counseling • Cognitive distortions • Health teaching • Self-care

  20. Anorexia Nervosa: Intervention Continued • Long-term treatment/advanced practice interventions • Psychotherapy • Psychopharmacology • Fluoxetine (Prozac) • Olanzapine (Zyprexa)

  21. Anorexia Nervosa: Evaluation • If weight falls below the goal, treatment is changed

  22. Therapeutic Relationship: Building Trust and Having Empathy • Client with bulimia nervosa • Sensitive to perceptions of others • May feel • Shame • Out of control • Low self-esteem • Unworthiness • Dysphoria

  23. Bulimia Nervosa: Nursing Process • Assessment • Nursing diagnosis • Outcome criteria • Short-term • Long-term • Planning

  24. Bulimia Nervosa: Intervention • Acute phase/basic level intervention • Milieu therapy • Interrupt binge-purge cycle • Prevent disordered eating behaviors • Counseling • Health teaching • Long-term treatment/advanced practice interventions • Psychotherapy • Cognitive-behavioral • Psychopharmacology • Fluoxetine (Prozac)

  25. Bulimia Nervosa: Evaluation • Normalize eating pattern • Maintain regular exercise plan • Weight in normal range for height

  26. Binge Eating Disorder • A variant of compulsive overeating • Reported in 20% to 30% of obese clients • No compensatory behaviors • Major depression a significant comorbidity • Most effective treatment is cognitive-behavioral therapy • Selective serotonin reuptake inhibitors used in treatment

  27. Binge Eating Disorder • A variant of compulsive overeating • Reported in 20% to 30% of obese clients • No compensatory behaviors • Major depression a significant comorbidity • Most effective treatment is cognitive-behavioral therapy • Selective serotonin reuptake inhibitors used in treatment